Podcast: Healthy eating through fatigue with Audra Starkey

Episode: 46
Guest: Audra Starkey
Duration: 1:03:57
Tags: nutrition, healthy eating
Soundcloud: Listen to Episode 46

Audra Starkey is the Healthy Shift Worker. She left a career in aviation to pursue her interest in nutrition and now helps shift workers find holistic routines that support them to simultaneously juggle the demands of their work and their bodies. She joined Celeste on the Nurse & Midwife Support Podcast to discuss the causes of burnout and how shift workers can take action to protect their health.

Audra says:

“Nurses and midwives, you know, you're very stressed. Combine that with poor nutrition, that can really accelerate our fatigue. They really do kind of intertwine together, if I could talk about it from that angle. Now, the more stressed you are, the less you're likely to take care of yourself. This is why we really need to work on our stress from a lot of different angles.”

Thanks so much to Audra for joining us to share what she’s learned about preventing and treating fatigue as a shift worker. If you’re struggling with stress and fatigue, Nurse & Midwife Support always here — 1800 667 877 or by email. Free, confidential, 24/7.

About Audra Starkey

After 21 years of working in the aviation industry, in October 2014 Audra took a leap of faith and accepted a voluntary redundancy to pursue her interest in nutrition, with a special focus on shift work health. completed a Bachelor of Health Science degree majoring in Nutritional Medicine from Endeavour College of Natural Health in Brisbane and has since launched The Healthy Shift Worker, a website and suite of resources devoted to helping shift workers develop holistic routines that support their health.

Celeste Pinney [0:09] Welcome to the Nurse & Midwife Support podcast: Your Health Matters. I'm Celeste Pinney, your podcast host. I'm the Stakeholder Engagement Coordinator with Nurse & Midwife Support and I'm a midwife. Nurse & Midwife Support is a national support service for nurses, midwives and students. Our service is anonymous, confidential and free and you can call us anytime you need support on 1800 667 877, or contact us via our website at nmsupport.org.au.

I'd like to begin today by acknowledging the traditional custodians of the land on which each of us meet and pay my respect to First Nations elders, past and present. I extend that respect to Aboriginal and Torres Strait Islander people listening today.

Today's podcast is about fatigue. Fatigue is an issue that nurses and midwives know well. Many of us have and will experience fatigue on a regular basis. The reality is that working rotating shifts interferes with the proper functioning of our circadian rhythm, making it hard to get enough quality sleep. On top of that, the stress we experience at work can create even more feelings of tiredness. It can be hard to take care of ourselves—eating well, exercising, and having enough rest and downtime—when we are working a lot and feeling tired.

However, it's not all doom and gloom because there are ways in which we can support our health to reduce and better manage fatigue levels. Today we welcome Audra Starkey to talk to us about all things fatigue-related. Audra is a clinically trained nutritionist, accredited trainer, shift work veteran, and author of the best selling book, 'Too Tired to Cook.' Audra is also the founder of The Healthy Shift Worker, a company that provides lifestyle and preventative medicine wellness services specific to those working in shift work industries, along with facilitating corporate wellness seminars for organisations that employ shift workers.

Welcome, Audra.

Audra Starkey [2:01] Hi, Celeste. Thank you.

Celeste Pinney [2:03] Thanks so much for coming on. Would you mind telling us a little bit about yourself and the work you do?

Audra Starkey [2:09] My background ... starting out in the aviation industry. So I have to put my hand up. I have not been a nurse or a midwife. I have family members that are, though. So I do have that connection, but I certainly know shift work having done it for over two decades myself, working in the aviation industry. I struggled just like most of us. I certainly struggled. Within that time frame, quite astonishingly, at no point did I ever receive any health and wellbeing training to help me to cope while I was working. I had a lot of training, obviously, with my role, with corporate training and so forth, but nothing specifically to help me to work out how to work this job. Which I absolutely loved, I have to admit as well, I loved my job. I didn't I didn't want to leave, because I really enjoyed it. But I knew I had to find a way to manage it so that I could keep going.

So I went off and did my own research, I guess, and started down the rabbit hole of learning the importance of nutrition and sleep. It's a massive rabbit hole, that is for sure! However, it really did set me on the path [of] wanting to, once I was learning this, to be able to give back and share the information that I needed. Because even though the information is there, sort of hidden in the background, it's not being put at the forefront to those that are actually needing it. Which is why I ended up going back to university, finishing my degree and writing my book, as you said.

Then starting to see clients one on one, doing online courses and also doing a lot of speaking in workplaces as well, and my podcasts and everything. I'm very much wanting to get the message out in front of as many people as I can, hence my book and so forth, because there are things that we can do, despite it being challenging. There are certainly plenty of things that we can do to help to mitigate some of the effects working shift work has on our health and I'm certainly very passionate in trying to get that message out there to help as many people as I can.

Celeste Pinney [4:40] Yeah, that sounds like very important work you're doing and so needed in many sectors, but particularly for nurses and midwives who struggle with things like tiredness and maybe not eating as well as they would like to. With the book you've written, 'Too Tired to Cook,' could you tell us a little bit more about the book?

Audra Starkey [5:00] Yeah, like I've mentioned, I've been doing this for a while now, but 20 years ago, or more than that now, I was searching for a book to help me to manage shift work and I couldn't find one. I found lots of sleep-related books, but they weren't specific to shift work. They sort of say, you know, go to bed when you're tired, and so forth. But I mean, none of it was relevant, for shift workers. I remember reading a quote, and it said, 'if there's a book that you want to write, but it hasn't been written yet, then you must write it.' So I did.

It's really a very holistic book. It's based around the five biggest struggles and underlying causes of fatigue, because we know fatigue is that big one. It shares, obviously, my research that I've done, coming up to those five biggest struggles, but it's also based on my own personal journey, and that of my workmates as well. It's broken up into those five main struggles, which are that underlying cause of fatigue being sleep deprivation and disruption, weight gain, stress/anxiety/depression, having a low immunity, and the last one being struggling with a disrupted family and social life.

It's a very holistic take. I do have recipes at the end of it as well, because I know that's what people are looking for. But the book is not long, it's almost like fiction, you know, a small book. It's designed to be an easy read, a conversational [read], because I was very mindful that the people who are picking up this book are tired and exhausted. I wanted it to be a bit of an entertaining read intertwined with science and common sense principles. I've had a lot of people send messages to me saying, oh, they loved it. 'I read it in 24 hours or a couple of days,' I was quite amazed that they read it that quick[ly]. But it's an easy read, addressing a lot of things that aren't spoken about and [it] makes people feel that they're not alone. Another way I used to describe my book, it's like a little bit of a big hug, to say, 'you're not alone. This is hard, let's talk about it and look at some strategies to help.'

Celeste Pinney [6:19] That sounds good, something simple, that is accessible, and it's not going to take people weeks or months to get through. I think that's really needed with time-poor healthcare workers.

Audra Starkey [7:37] You're reading research articles, and [it's] quite intense [about] the stuff that you read for work, I wanted this to be a little bit more lighthearted. Although it is obviously very much backed by evidence-based principles and research.

Celeste Pinney [7:52] Yeah, fantastic. That sounds great. In your role, you're obviously working closely with shift workers to help improve their health and wellbeing and it sounds like you've done an incredible amount of research into that. Love to hear your thoughts on what you're seeing in terms of the struggles people have with fatigue, and the main reasons that are causing people, particularly nurses and midwives, to feel tired.

Audra Starkey [8:16] Yeah, well, the struggles! I guess, there's everything that I mentioned in my book. Those five key areas, and also now though, it really is leading on to bordering on that burnout, because they really are burning the candle at both ends, and I used to also describe it sometimes as setting light to the bit in the middle as well. It's certainly very challenging. There's so many causes, of course, it's very multifactorial, but the big one is insufficient sleep and rest. For so many nurses and midwives that I see out there. Their body is constantly in that fight or flight stress mode, just from doing the shift work itself because of that lack of sleep. But when you're in a stressful environment and you're working shift work, that mind and body is kind of stuck in the 'on' mode. Because of their different types of rosters that they're doing, and they're just leading very busy lives, they're also not resting. So of course that's certainly going to be one of the big drivers behind fatigue.

A few of the other ones are insufficient water intake, dare I say it! Sleep deprivation is one of our biggest drivers of fatigue and stress of course, but so is lack of water. Dehydration is huge and water ... and I mean water, not fluid, things like coffee and energy drinks. Some of the energy drinks in particular contain quite toxic ingredients, also some of them are very high in caffeine, which acts like a diuretic, as you know, increases production of urine. So you might think you're actually hydrating yourself, but in fact, it can actually lead to making you feel even more dehydrated and of course, that compounds further in fatigue.

The other one, of course, is that they're malnourished. What I mean by malnourished, you might think that's crazy, people are eating, but they're not really eating the right foods. Too much highly refined and processed foods goes hand in hand with shift workers, unfortunately, because you get stuck in that cycle of too tired to cook, so you don't necessarily cook from home so much, and you don't make the best choices. But meals are our medicine. If you look at it that way, the food that we put in our mouth is the information the body draws on to drive its internal operation system, which of course, is essentially our biochemistry.

So those three are usually the big ones. Combine that with working maybe too much overtime, too many night shifts in a row, or there's too [many] rotating shifts going on over a short period of time, so they're not having time to recover. Another big one, which I'll probably touch on a little bit more as we go into the conversation, but also lack of time in sunlight and nature. [In] your jobs as midwives and nurses you spend the majority of your time indoors, during daylight and at nighttime, so we've kind of forgotten to connect with nature. Sunlight in particular is a big driver in helping to recalibrate our circadian rhythms, which has a big influence on our hormones and neurotransmitters which influence our fatigue.

Celeste Pinney [11:59] Yeah, it's very interesting. I think those three points that you mentioned, I can see how they're some of the main drivers in causing fatigue, and it would be good to go into the nutritional side of things in a minute, but I'd love to hear a little bit more from you about in your experience and [given] what you know, how can people ... given the constraints they have on their sleep because of their roster and juggling other commitments, family, children, things like that ... what are some ways in which people can get better sleep, improve their sleep, and get more sleep as they go through their working life?

Audra Starkey [12:42] Yeah, okay. I'll probably mainly focus on three key things, but number one is to really nurture and nourish your circadian rhythm. Because your circadian rhythm as a shift worker gets disrupted so much, the shift work role does that, but there are other things that are also disrupting that rhythm. Light is one of the biggest disruptors to our circadian rhythm, as I mentioned, being always indoors. Other things though, our food can influence it, the timing that we're eating, and so forth. Shift work is that thing that we can't necessarily change, but we have to be mindful of the other things that might be inadvertently, unknowingly disrupting our circadian rhythm further.

Having too much light at the wrong times, and obviously not getting enough darkness is something that we do experience working shift work. But on your days off, get outside and spend 10-15 minutes in the sunlight, barefoot on the ground. Either on your days off or if you're on late shifts, you can do this. Just getting that sun exposure helps to recalibrate the hormones cortisol, melatonin and serotonin so that you don't feel so fatigued and just tired because when we spend so much time indoors, it's sending a message to the brain, that it's dark and that it's nighttime. So of course we're going to feel tired. Indoor lighting gives off not the same lux as sunlight does. So we need to be getting outside. We're designed to be outside and not indoors. That's the first one: nurture and nourish your circadian rhythm.

The second one—I want everyone to really think seriously about this one—is to go into your bedroom and have a look at it. Does it look like it's inviting to you? Because you really want to [feel comfortable,] if not overhaul your bedroom and make it into a sleep sanctuary. The hotel industry: this is what they do. Their number one focus is to make sure that their guests sleep very well. Now considering we spend a third of our lives in bed sleeping we really need to redirect our focus and put it back into that area. We will spend a fortune on our cars and our clothes and so forth. Our bedroom is something that gets neglected.

I recommend to my clients to go and buy the best linen that you can, with the highest thread count. Your bamboo sheets, cotton sheets, things that are going to help your body to breathe so you can sleep well, the best bed, pillows, etc. There is a great little sleep lamp that I'll recommend. I'm not tied with it, I'm not on commission or anything, but there's a company called Block Blue Light, and they have a fantastic little sleep lamp that you put beside your bed. It's called the NoBlue Amber Sleep Lamp and it gives off the most beautiful orange glow, which helps to kind of reflect what a fire is, you know, that has that orange rather than that bright white light which can impact on our ability to sleep. So really investing in your bedroom.

Of course, the basic [rule] is we've got to be serious about removing our mobile phone from the bedroom. I know this is a bit difficult when you're on call, but when you're not because besides sunlight, it's a visual cue that increases excitability which can impair your sleep. So yeah, really look at your bedroom. You want it to be where you really want to sleep and be able to sleep well, like a hotel room.

The third thing I want people to [consider] ... again, you might not think about this when it comes to sleep, but it does come back to that dehydration thing, is to drink more water; but to drink more filtered water. Most of our tap water contains a high amount of fluoride, chlorine and pesticides etc, which can actually impair the function of the pineal gland. Now, the pineal gland is in our brain and contains photoreceptors that switch hormones and neurotransmitters on and off in response to sunlight, but it's also responsible for producing our sleep-regulating hormone melatonin. If we're drinking too much tap water, it's been shown in the research that it can actually calcify that pineal gland. That lovely gland that is responsible for producing melatonin which we desperately love and want more of, to help with our sleep.

Again, it's getting back to supporting our body as much as we can. Before maybe reaching for the melatonin, just doing those few things for at least a couple of months. You really should notice the difference in your sleep. Of course, I'm not saying to not take medication, because there's absolutely a time and a place where medication is needed. But if you can get back to a certain lifestyle medicine approach such as these, they can certainly make a difference in improving sleep.

Celeste Pinney [18:03] Hmm. Yeah, I love the light concept. We evolved under the sun, outdoors, for millions of years. Now that a lot of us spend most of our time indoors I can see how that would really disrupt sleep and the ability to feel awake.

For people who are, say, working an early shift, they might start at 7am and go through 3.30, is it still beneficial to go outside? I know probably morning light is best but if you can't get out before lunchtime. Is it still helpful to go out if you can on your lunch break, sit in the courtyard or in an outdoor area, just to help bring in that signal of the light?

Audra Starkey [18:42] Oh, 100%. Yeah, absolutely. Because being in that dull light, as I said before, it's sending a signal to the brain that it's night time. So it's gonna make you feel sleepy and groggy. By getting outside, getting that sunlight exposure with a much higher UV and lux, you just feel more invigorated. If you can, it's not always possible in all hospital settings, but take your shoes off and stand on the grass. Do a little bit of earthing. Really connect to Mother Earth and connect back to nature because we really are disconnected. You might be working on the fifth or the sixth floor, you've got your shoes on, you're working in this dull sort of light environment, it's only natural that you're going to be feeling tired and fatigued if you're on your feet all day, as well.

Celeste Pinney [19:44] Yeah, that's great. What about for people working night duty, because night duty, it can be really challenging to get good sleep and you're reversing the time that you're normally awake. We're biologically programmed to sleep at night, but when people are having to be awake in the night, is there anything that they can use with light to help themselves be asleep better during the day and be a bit more awake at night time?

Audra Starkey [20:10] Yeah. After that night shift, put some sunglasses on the drive home. It'd be ideal if you could leave that hospital and go through some kind of underground tunnel to make it back home, so you didn't have to drive in that early morning sunrise, which is really doing the opposite to what you desperately want to do. One way to overcome that is to just put some sunglasses on, and then get inside and just do the reverse. Close up all the blinds, the curtains and everything, just to make your environment as dark and quiet as possible. Because we can't sleep if that light ends up going in our eyes. Of course, sleep masks help if you're still getting that light. I know I'm very, very sensitive to light, even if I've got curtains drawn and blinds down, sometimes I've still got to put that mask on. Doing whatever you can to trick the body to have more darkness.

That's the thing, we are light deficient, but we're also darkness deficient. Especially night shifters, because you are spending so much time at work under those artificial lights and you're physically wandering around at two or three o'clock in the morning when your body's definitely craving sleep, but you're pushing it to do the opposite. We have to work with our rhythms as much as we possibly can.

Celeste Pinney [21:50] Okay, that's great. There's some good tips. So it's just appropriate light, as much as possible, at particular times of the day. In the morning, or earlier in the day, lunchtime, getting some light and then in the evening trying to reduce light so that you're getting the darkness prior to bed so that you're giving your body the chance to become sleepy and produce the right hormones. Sounds like that's what you're saying.

Audra Starkey [22:13] Yeah, exactly. I guess the best tip I can give for the night shifters out there ... obviously, when you're on your final night shift, you are going to drive home and you're going to come home and you are going to sleep. You're going to maybe sleep through till lunchtime, so then you just get up and be up for the rest of the afternoon. Be very gentle, don't do anything that's high stress, just take it easy, because your body's exhausted. But you want it to still be a little bit exhausted so it does sleep at night.

Then that first day off, so you've done your night shift, come home, slept half a day, I'm talking about the very next day, in order to help reset your circadian rhythms. If you're going back onto days off, or late shifts or anything, that's when you get up. Even if you have to drag your body out, if you can, in your pyjamas in the backyard, just getting outside first thing in the morning, or at least when you wake up, just to get that sun exposure for 10-15 minutes. Honestly, it might sound so simple, but it really can make a difference in how you feel and just getting back into some kind of a routine.

Celeste Pinney [23:22] Great, great, thank you. I'd love to sort of shift a little bit now to the nutritional side of things because I know you've got some great information on your website, and it sounds like in your book, about particular foods that people can eat to support their health, but also for people who are working rotating shifts and say the night duty and having to eat in the night, which is a time that humans wouldn't normally be eating. I'd love to hear what information you've got regarding that.

Audra Starkey [23:53] Yeah, so obviously shift workers are stressed. Nurses and midwives, you know, you're very stressed. Combine that with poor nutrition, that can really accelerate our fatigue. They really do kind of intertwine together, if I could talk about it from that angle. Now, the more stressed you are, the less you're likely to take care of yourself. This is why we really need to work on our stress from a lot of different angles. But of course it can trigger things like emotional eating as a coping mechanism. We seek out comfort foods that are high in calories. We tend to do that. I do know that at a lot of nursing stations, there are those drawers that have all those little goodies. I've seen them, they've been in my [inaudible] as well. It's very easy to get tempted to just, once you have one, you're just continually wanting to have more.

So before I get into a little bit of that, I want to work on the stress bit first, which then leads us into nutrition, because I think that's important. This alludes to what we were talking a little bit about before: getting outside. I just want to give you a couple of tips to help reduce stress. If you can, when you can, take your breaks outside because that sunlight, that fresh air, that change of scene, can just help to make you feel a little bit more half-human, for a better word. You might be wanting to reach for the vending machine, keep walking past that vending machine, jump in the lift and go downstairs and if you can, get outside, spend a few minutes out there with your break. Of course, though, that's something that you can change, and we can't always change things that are happening at work. But of course, the moment that we do leave work, we have full control.

This gets back to doing more things that make you and help you to unwind, because we're not doing that anymore, we're just kind of 'work, work work' and everything is very busy. We're forgetting to take care of ourselves. That's one thing, certainly, health practitioners are guilty of. They are fantastic, they are phenomenal at taking care of other people, but they tend to, unfortunately, forget about taking care of themselves.

So doing more things that are happy, helping you to unwind. When you get home, put some chill out music on or something, do whatever it takes just to help you to de-stress. I do want to touch on something that I wish every shift worker would do, is actually to take up yoga. Yoga is fantastic at helping to calm the nervous system, to support the nervous system, to help you feel so much calmer overall. You're not as triggered when things do feel stressful, once you've been practising it for a while. One of my yoga instructors is actually a nurse herself, she got into it for that very reason, to help her.

I wanted to give you a few little tips and strategies first, just leading into that, because if we work on the stress, we're more likely to eat better. We want to put the cart before the horse, so that we're setting ourselves up for success. We want to make things easier for ourselves. If we're less stressed, we're more likely to eat better and not have that emotional eating. When it comes to nutrition, in order to help as best you can with the challenges that you have, whilst working in a very stressful shift working environment ... number one is that you really need to minimise feelings of hunger, because you are sleep deprived. Sleep deprivation unfortunately messes with our hormones, particularly our appetite-regulating hormones like leptin and ghrelin. When you're sleep deprived, you're less likely to receive the signal to tell you that you're feeling full, which is leptin, and you're likely to get more of the ghrelin hormone, which is produced in the lining of the stomach, telling you that you're hungry. It's a bit of a mental game that you've got to play sometimes.

Of course, highly processed foods are laden with sugar, salt, and chemical additives, and they're devoid of micronutrients. When you are stressed and you go for highly processed foods, you're actually making things worse. You think you are giving your body something to eat, but it's actually only making you more malnourished because it's adding a toxic burden to your body, to your liver, to your kidneys, everything that has to break down these foreign things that the body doesn't really know how to break down normally, as opposed to real food. Highly processed foods, I'm talking about those vending machine foods, sorry! And a lot of us [have] cafeterias in our hospitals, sadly enough, [those foods are] very high in calories, but they lack nutrition. It puts us in a nutrient deficit and it stimulates a drug-like desire to eat more.

The more junk food we eat, the more of them we want to eat, because we're not filling that gap. If we don't eat enough nutrients, we're going to be constantly hungry. If there's anything that people [take away] besides sleep focus that I've done on this podcast, I really want you to remember that if you don't eat enough nutrients, you're going to be constantly hungry.

When you sit down to eat your meal, or whatever it is, [ask] does that look like it's going to nourish me, or is it more likely to make me feel worse? We need to eat more real food to fill us up, because real food is filling. It contains all the micronutrients and macronutrients, the phytochemicals, antioxidants, etc, to provide us with sustained energy. I know a lot of people were sort of worried about weight loss, gaining weight, and everything like that. You don't have to eat less, you just have to eat right. That's another thing to keep in mind as well.

Another two important things that I want to refer to from a nutrition perspective, is this is a little bit different again. I kind of like to flip things around a little bit, but to really sit down and do a habit self-assessment. Ask yourself this: What am I currently eating now that I know, deep down, is not serving me? Eg. there's this kind of habit that you've got into, grabbing a particular chocolate bar from the vending machine each time I'm on X kind of shift. Instead, what can you make or bring from home that is a healthier option each time that you might be on this shift? For example, maybe you might want to make a guacamole or a beetroot and feta dip and with some hard boiled eggs and celery sticks just to have some good, nourishing food on hand so that you're not ... I know that's not a chocolate bar. But it's going to definitely leave you feeling fuller, and make you have better mental clarity as well.

This is another big thing, if we're not feeding our bodies properly, you're going to really struggle with your mental clarity. That can lead to obviously making, you know not intentionally but making unintentional errors. You've got to sometimes make really quick decisions quite fast. Midwives, especially. I know that I've had quite a few clients that are midwives. I can appreciate the sort of stressful situations that you're under, but you need to be feeding yourself and your brain so that you can make those decisions better. The other one is, am I eating at my desk or workstation, am I doing that all the time? Maybe it's time to get up and go into the lunch room, just little baby steps.

Then the third one ... this might be a new concept for some of you. Because I know in the general nutrition advice that's given out for those that are night shift, they tend to say just flip your meals around based on your work time. I completely disagree with that. I've done quite a lot of research on this, because it comes under an area of food timing or chrononutrition, but it is too fast overnight. By this I mean not eating around midnight to 6am. That might sound a very long time, and if it's something that is quite new to you, you can start small, but we really want to have a good chunk of fasting overnight because our body is not designed not only to be up and working at night, but also not designed to be eating at night. Fasting enables something called the migrating motor complex, which is essentially the gut's housekeeping system to kick in and work. It helps food move through the digestive tract, keeping you regular, minimising gut discomforts and so forth, which I know is very prevalent in nurses, midwives, and shift workers overall. But when we fast, that's the only time that this migrating motor complex in the gut is able to work.

Unfortunately, as I said, when we work 24/7, we tend to eat 24/7. The body is not designed to function in that way. You might think, well, if I don't eat, I won't be able to think straight. Again, it's eating smarter and being mindful of the timing, being mindful of the food choices. Not having food in the digestive tract actually can help you to feel more alert, because each time we digest food, all that blood has to be diverted away from our brain into our gut and so it can actually make us feel tired and sleepy.

So this is an area of research. As I said, in scientific literature it's called chrononutrition or circadian nutrition. It's very obviously prevalent, or very applicable, for those working in the shift working realm, where they are up during the night. So that's a bit of a long-winded answer to your question! I'm sorry, Celeste, but I want to get the different points across as best as I can.

Celeste Pinney [34:20] No, no, it's great. I know nutrition is a very big topic generally but even more so when we're adding in people who are having to eat at different times or who possibly don't have the energy or time for preparing healthy meals.

Would you mind giving us some examples of, say, what would be considered a really good, healthy, quality meal? Like I know there's lots of different meals people could have, but just to give people some sort of idea, that would give them energy, that's got the appropriate macro/micro nutrients?

Audra Starkey [34:56] Yeah, so I guess that depends on the shift itself. For a breakfast option, you're really wanting to have something that's not too carb-heavy, which is obviously going to stimulate a bit of a high blood sugar crash and drop. So in which we know we tend to go for the coffee and the muffin and usually an hour later, we're hungry because you've got that blood sugar crash. So I know you can make this at home in advance, things like mini quiches. Or a whole quiche, and then just chop it up into quarters, because obviously eggs are very high in proteins and healthy fats, which the brain needs in order to function, and very satiating as well. Quiches are fantastic, because you can also throw whatever you want in them, your mushrooms, your capsicums, your spinach. Actually, green leafy vegetables are fantastic, we need to be having more of those, they're high in things like magnesium, which does help with stress.

Because we're sort of used to understanding our breakfast has to be some kind of a boxed cereal, or a bowl of [muesli?], or something like that. But it's all sugar. I have chills down my spine every time I go down a grocery aisle where the box cereals are, because very few of [those] contain any nourishment at all, if you actually do take the time to turn it around and read the ingredients label, what's actually in them, a lot of them we can't even pronounce. So just switching more to having your savoury breakfast ... in saying that, if you are more of a sweeter person, maybe something with overnight oats. But if you're going to have overnight oats, soaking them in milk, or yoghourt, or something. Rather than having those overnight oats or porridge on its own.

Again, to really up the macro and micronutrient profile of the foods, a great thing to do is put lots of different types of nuts and seeds and shaved coconut, maybe chopped berries or banana, or whatever else is in season. That will actually help to minimise that blood glucose spike and help you to feel fuller for longer, and you're not likely to want to sort of snack on anything. When it comes to night shift eating, as I said, I really highly recommend that good chunk of time for fasting. But before you go into work, I know this is going to depend on the shifts/times, because every nurse, every hospital around Australia has all different night shift and shift times. But you can just adapt this the best way that you can.

So for example, if you're working starting at like, 11 o'clock at night, then obviously having your dinner, your normal dinner. Honestly, just have dinner like you would normally, with your meat and three vegetables or whatever it is, because that's going to really leave you feeling full. Then, a little bit closer to midnight, maybe have another small snack if you feel that you need to. If that is the case, and you're feeling like you do need to eat something during that night, maybe a very small serving of a slow cooker, or a dish that's been broken down a lot, or a nourishing soup. Homemade tomato soup with maybe some extra vegetables through it just to beef it up a little bit. But I do love soups, and I love slow-cooked foods because they kind of pre-broken down. So they're going to be quite easy to digest and keep you feeling full.

There is this thing that we've been sort of told for so long; that we need to have three meals a day and snacks in between. I'm much more focused, more than ever now, is you really need to get back to eating more intuitively and don't stress about it. Don't feel guilty for having that occasional chocolate bar. I mean, gosh, you're a shift worker, you've got to give yourself a treat every now and then! But it's really eating more intuitively and just choosing more wholefoods, as opposed to the highly refined, processed stuff.

Celeste Pinney [39:39] That's great. Yeah, I think it's good for people to have some specific examples of what you consider healthy types of food and how they can eat on night shift because it is a time when the body's already under a bit of stress. So just assisting that digestive system to have an easier time is great. That's really good to hear about some things people can do with stress, with nutrition, with sleep.

Is there anything else that you found in your work with people, or in your research, that nurses and midwives could do to help with fatigue?

Audra Starkey [40:20] Yeah, the number one thing, believe it or not, that I try and tell everyone is to prioritise their sleep. A lot of people might roll their eyes and hear about that, because it might seem obvious as shift workers, that we must prioritise our sleep. Unfortunately, a lot of us don't, and it's really been pushed to the sideline how incredibly important sleep is.

Sleep affects every single aspect of our being. I know it's not easy. I know a lot of nurses and midwives, they're kind of juggling everything. They're juggling a work life, they're juggling a busy home life, they've got a lot of things going on. But there's always areas where we can improve our sleep. I've given a few little tips earlier on about improving your bedroom and everything like that, making it a bit of a sleep sanctuary, but prioritising our sleep is so incredibly important.

Time is our most precious resource, we can't get it back. But I know so many of us, we are, sadly, quite addicted to our mobile phones. We need to be spending a lot less time on them. That is, it's quite quickly how we lose all of a sudden, it's like oh my gosh, where's that half an hour gone? I've just been scrolling mindlessly on the internet. But as I said, sleep affects every aspect of our being.

I'm trying to get it out there, to have this big focus. Nutrition is important. But dare I say it, even as a nutritionist, I say that sleep is actually more important. I do put this on a ladder when I'm talking about this in my workshops. It might seem a strange thing for a nutritionist to say, "Well, actually no, nutrition is not as important as sleep." Eat absolutely is [inaudible], particularly for shift workers. I can use an example, and I'm not saying to do this anytime soon. But if you were to go on a diet or whatever, and not eat for three days, after that time, no doubt, you would feel tired, you'd feel weary, you'd probably lose a bit of muscle mass, but generally speaking, you're gonna be okay. But if you go three days without sleeping, you're barely gonna be able to function, and you're going to start hallucinating.

Now, three days is an extreme example. However, I know from working with clients that, for example, for those that are on night shift, so many of my clients, they will go into their very first night shift on no sleep, or half an hour of sleep, but they don't understand how that's going to quickly compound. If you've been up since six o'clock that first morning and then you're soldiering through, it's just going to snowball and you have to be mindful that a tired brain can't function as it normally does. It struggles to make rational decisions. If you're driving a car, your reaction times decrease. There's so much research out there on this. I really want people to understand how critically important sleep is, and to protect it like your life depends on it, because it absolutely does.

There is a great app out there for those of you who resonate with my addiction to phone scenario. There's an app called Minimalist Phone that you can download. It's a great little app that can help reeducate you on spending less time on your phone. I know that we're all guilty of this in some way, shape, or form. But if you get back an hour or two of that time spent on your phone that you could have been sleeping as one of my clients said, she'd be up, you know, she'd go to bed but she'd feel guilty about going to bed. 'I've got too many things I need to be doing. I need to be doing the washing, or I need to be cleaning up. My gosh, this one lady in particular, she spent more of her time cleaning out a cupboard, even though she had an early the next day. We need to redirect our priorities back.

That's the big big one, of course. The second one that can help with fatigue, which I've already really touched on I guess, Celeste, but we really don't have to necessarily have the three meals a day with snacks in between. When you're doing that, your body is constantly in digestion mode. It's working very, very hard, which means it's not resting either, which is going to impact on your fatigue. Shift workers, we work 24/7, which also means we're eating all of the time. We're not meant to be doing that, again, getting back to that migrating motor complex that I touched on before. The act of digestion is exhausting, which is why I really do try to encourage people. Where they can, just start small, but if you can fast overnight ...

Celeste Pinney [45:28] Yeah, those are some really good tips. I think it sounds like some of this is around habits and people maybe looking at their habits and some things that they can do to shift some patterns that they have that might help improve sleep. I think the stress component comes into that with, if we come home, we're really stressed, and then we keep stimulating ourselves with phone usage, it can be harder to wind down for sleep.

I know there's a lot of talk about having the wind-down time before sleep. I imagine you know all about that. What do you think [about] nurses and midwives who come home from a late shift at nine or 10 o'clock at night, and most likely it's been quite stressful and busy? Is there anything that people can do to help themselves calm and get ready for sleep? Because it can be tricky to go straight to sleep when you come home from work at that time.

Audra Starkey [46:28] Yeah, absolutely. I'm glad that you touched on the alcohol bit. Because yeah, so many health practitioners or shift workers overall, particularly after a very highly stressful day, we will go home and we will reach for that wine. It will start with one, and maybe we might go for another. And yes, alcohol is a sedative, it actually does help you to fall asleep. However it actually breaks up your sleep, it impairs the actual sleep cycle, our REM sleep, which has got to do with memories, recall and learning and all that kind of stuff. Which is why we wake up [with] a hangover, we might be lying down horizontal, thinking that we're asleep because you've fallen asleep on the couch. But your sleep quality just takes a massive, massive nosedive. So yeah, if alcohol is one, I would really try to find ways where you can slowly dissipate that and replace it with other things.

So yeah, coming home, having even ... I know this is going to probably be a bit of a special occasion. If it's a really bad shift, come home and have a bath. Put some chillout music on. Or if you don't want to go to the trouble of having a bath, even having a shower, put some chillout music on in the background, take a seat on your couch, just do some deep breathing.

There's something called box breathing, where you're breathing in four, hold for four, breathe out for four. Breathing in, hold, out, and just going around in that sort of a circle. It's tapping into diaphragmatic breathing. One of the few ways where you really are actually able to tap into that autonomic nervous system is through breath. The research is all out there, it's one of the few ways where you really can have some kind of control over that autonomic nervous system.

We really want to get them out of that fight or flight stress response into that parasympathetic rest and digest, and deep breathing can actually do that. Obviously, sitting down, putting on that little lamp that I [talked about]. You don't want to put the bright lights on when you're coming home, because that's going to keep you awake, and not help you to wind down. So getting a sort of softer, amber lighting.

Then maybe sitting and reading a book. I've even recommended to some of my clients, if you are somebody that really does struggle to sleep, even with a book, read something incredibly boring. Go and get your fridge instruction manual, or something like that. Something that you're going to start reading and it's just going to put you to sleep.

That's important, and also being cool is very important. The body won't sleep if you're too hot. Going to bed, even initially, without having a doona over the top of you or a sheet. Just making sure that you're cool. Then, just before falling asleep, maybe pull up your doona then. But it's really important that the body is actually cool enough, otherwise you won't actually be able to fall asleep.

Celeste Pinney [50:04] That's really good to know, that there are some practical strategies that people can use that are quick and simple, such as having a bath, doing some breathing exercises, to shift away from the sympathetic fight/flight part of the nervous system. Because it can be difficult sleeping after a late shift. So, really good to hear that.

Lastly, I'd love to hear what your thoughts are around what employers might be able to do to help change the work environment, or the way that the work structure is set up, that helps to promote sleep and reduce fatigue levels. We've talked a lot about what nurses and midwives can do as individuals, but we know that some things are outside of their control, like our rosters, not enough time off and in between shifts, having to work night duty. So yeah, just love to hear your thoughts on that.

Audra Starkey [21:00] Yeah, I think that's a really great question, Celeste. Because as individuals, it is very important that we certainly take ownership of our habits, and what we need to be doing to help foster our own self-care. But it's also really a two [part] responsibility role, where the employer does need to take on a certain type of ownership. You're more likely to get employee satisfaction if they can see that you're wanting to help them, as well.

So I think that's a really great question. It's not something that is spoken about, or at least having this open discussion. First and foremost, this always comes back to my passion with the sleep prioritisation and importance of it, but there is an insurmountable amount of research out there showing the deleterious effects of insufficient sleep. By that, I really think that employers need to sit back and look at the rostering system that they have, and to make sure that staff members have a sufficient amount of time in between shifts to rest. We can refer to that dreaded late/early shift, which is common practice in many hospitals around Australia.

But just to put that into context, if we were to look at ... I refer to them as our nine to five non-shift working cousins, they actually have 16 hours between their shifts, per se. So if they were to start work at nine, finish at five, even if they had to go through to six o'clock or whatever, they're not due back again till the following day at nine o'clock. They're looking at about a 16 hour gap between when they sign off, and when they're signing back on again. They also have the beauty of sleeping during the night, not having it upside down.

They are getting absolutely the best opportunity to have good quality and good quantity sleep. 16 hours versus, I know some places have eight hour turnarounds, which personally, I think really needs to be in good consideration, they need to be looking at phasing those out, because it's not supporting the staff member to get a sufficient amount of sleep. We're meant to be getting around seven to nine hours. So if there's an eight hour turnaround, it's already gone because you have to add in, obviously, that that commute time, that wind down time, and then coming back again to shift, so it's just not going to happen.

I really do think that it should be at least a minimum of 12 hours to give that staff member ample opportunity to be able to get sufficient sleep. It will automatically reduce the stress, reduce sick leave, which obviously, from a financial perspective, is a win-win scenario.

The other thing that I think employers need to look at is ensuring that staff members have sufficient time to eat. This means making sure that each staff member is getting a proper break, and that is not even eating at the workstation. I'm talking about being able to get up from their workstation if that's where they're sitting, and to be able to go into the lunch room and take a break and be able to eat in a more calm manner.

So many of my clients I've seen, certainly over the years, are plagued with various different gut complaints. But it's not always food related, it's timing, when they're eating, but also because they have to inhale their food at a rate of knots, under time pressure. Of course, that's going to interfere with digestion and assimilation of nutrients, which is also going to lead to pain, discomfort, constipation and lethargy. Not to mention that there is a large percentage of our immune system located in our gut. There is that two-way street that's happening there. I think that they certainly need to be able to feel that they can take their break, and be able to take it properly, as if they were in any other normal workplace where they can get up and go to a different location, being the lunchroom or maybe they go downstairs and sit in a courtyard to have their lunch. Just being able to have that opportunity to do so.

Then the third thing, something that I personally would love to see, is having more ongoing educational workshops brought into the workplace, because we can't fix what we don't know. There is such a massive, gaping hole when it comes to ... which is wonderful, why we are doing this podcast, Celeste. Is for shift workers, what to actually eat. They go through spending many years at university being taught how to become a nurse. But then when they get there, they don't really have any idea of what, when and how they're meant to be eating. So I think that really does kind of need to be either employed into the curriculum, well, yes, definitely [that's] a start, but also bringing it into a hospital setting so that the staff members can actually learn what, where, and how to eat, because that all correlates with how well somebody sleeps as well.

If we're eating too much high sugar, it's going to impact on our sleep, and [that] also ties in with offering healthy vending machines within a workplace. I've seen it. I've been in hospitals, believe it or not, that have had healthy vending machines, and I know that so many staff members are screaming out for them. As you said, they don't always have time, maybe at home they're time-poor or they're exhausted, they just didn't get an opportunity to grab something to eat. So they're limited by what they can get in the hospital setting. The cafeteria might be closed, but at least having a vending machine that does have, you know, more wholefood options for staff members to have is going to set them up for being healthier staff members. If you have healthier staff members, you're having a healthier workforce, and that, of course, then leads to a very highly profitable organisation as well (being the hospital), when everything's kind of running quite well.

Celeste Pinney [58:01] Yeah, that's great. Really innovative ideas. I hope there are some managers and employees listening who are willing to consider taking on some of your ideas.

Well, we've come to the end of our time together today, Audra. Thank you so much for chatting with us, and for sharing all your wisdom and insight. It's been a great conversation. If people would love to learn a little bit more about you, where can they find you?

Audra Starkey [58:28] Yeah, if they just head over to my website, it's www.healthyshiftworker.com. As you eluded, I've written a lot of blogs over the years, there's a plethora of free resources available there. Just a few months ago, I actually did launch my membership site called the Healthy Shiftworker Club for those of you who might be interested. The aim for me was to provide an opportunity where people can learn from what I teach in my workplace wellness workshops, and so forth. They might be one off, but they have that ongoing support from either reading the book or listening to the podcast and so forth. They're not dictated by location or employment status. It's purely an online membership site that I've got for people that maybe have a strong desire to want to take care of themselves.

My next intake is in October, there is a waitlist form that people are welcome to register for so they get a notification when the doors open again, but all that information is available on my website at healthyshiftworker.com.

Celeste Pinney [59:43] Fantastic. Thanks for listening, everybody, today. If you would like to chat to us further with any issues you have and receive more support, you can call us on 1800 667 877, or you can find us at nmsupport.org.au.